Agreed.
Based on the studies on rats, I would expect that sleep deprivation could well eventually be fatal in humans. But I wouldn’t consider that FFI provides adequate evidence because there are other neurological effects besides insomnia.
Based on people staying awake for long periods of times like Tom Rounds & Randy Gardner, it seems like the neurological effects in FFI and SFI are caused by lack of sleep.
From Playboy when I was a kid in the '70s:
Mary had a little lamb
Given her to keep
It followed her around until
It died from lack of sleep
Lacking brain biopsies on Tom and Randy, I’m not sure we can conclude that. In FFI, Neuronal loss and gliosis that is maximal within the thalamus are consistently found.
The sequel to that being:
When Mary had a little lamb,
The Doctor was surprised.
But when old McDonald had a farm,
the Doctor nearly died!
There seems to be a question here: Does lack of sleep cause multiple other neurological problems, ultimately leading to death? Or is lack of sleep just one of a number of neurological problems occurring in parallel as a result of an underlying disorder?
Something I read on the subject once upon a time (sorry, no cite), mentioned that sleep is such a powerful need, that a sleep-deprived brain will fall asleep eventually. No matter what distractions there may be (bright lights, loud noise, as was used to drive Manuel Noriega out of hiding), or forcing the interrogation subjects to remain standing: Eventually, you will get sleepy enough that you will fall asleep.
That is, assuming the brain otherwise healthy and functioning normally. The kind of sleep deprivation that could lead to death necessarily can happen only in the presence of a brain disease like FFI, or drugs. At least, that was the implication that I saw there. So it’s kind of hard to separate those questions.
ETA: Conversely, I saw an article a while ago about a converse condition: Just like there are specific brain circuits involved in switching the brain from awake mode to sleep mode, which can cause insomnia if damaged, there are other brain circuits involved in switching from sleep mode to awake mode. These could also get damaged, in which case the patient might fall asleep and not be able to wake up. The article told of a patient who had a stroke that damaged that area of the brain, and fell asleep. Her husband became alarmed when he couldn’t wake her up. Fortunately in that case, they got her to a hospital in time, and with therapy, the patient recovered.
Whenever I hear of forced lack of sleep, I immediately think of the old film Stalag 17 (1953, and I believe Peter Graves’ breakthrough role). The Nazis kept that one POW awake for days as a means of torture to get him to tell how he managed to blow up a train despite being under guard.
How common is that as a means of torture? Seems like if people had died from in in large numbers, we’d know.
I can provide at least one data point confirming that. Either that or there really are leprechauns in business suits in the Midwest.
That’s just Warren Buffett.